The latest culture of nursing includes evidence-based practice. Without proven rationales, nursing interventions would not be substantiated with facts, and the credibility of nursing practice would suffer. Using descriptive and inferential statistics, evidence can be revealed, and the practice of nursing can be improved with better patient outcomes (Kim & Mallory, 2014). Within each specialty one can find evidence-based practice, such as the setting of critical care nursing, where many critically ill patients require mechanical ventilation due to acute respiratory failure secondary to the primary critical illness. Nutrition is a key component within the total care nursing practice that is typically observed in the critical care setting (Ramprasad & Kapoor, 2012).
Malnutrition can quickly develop due to the catabolism that occurs from critical illness, and secondary infections and impaired skin integrity can occur from such malnutrition. Therefore, it is vital that nutrition is started quickly with minimal interruptions to reduce
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In the adult intensive care unit, the patients who are mechanically ventilated with a need for enteral nutrition will be the population in question. The intervention is the use of small bowel enteral feedings, and the control is the feeding route via a gastric tube. The intervention and the control are the two aspects one wishes to compare. The outcome in question is decreased aspiration of enteral feedings. The research question can be stated as the following: In the adult intensive care unit, with ages ranging from 18-89 years, intubated and mechanically ventilated critically ill patients who require enteral nutrition will have a decreased risk for aspiration with the implementation of small bowel enteral nutrition compared to gastric enteral
Evidence-based practice (EBP) entails the use of explicit, reliable, and judicious evidence to make effective decisions about the care of patients. This DNP student will introduce EBP with the IOWA model. The IOWA model applies to this DNP proposal. The IOWA model is an EBP applicable in healthcare setting and implemented to show the applicability of evidence in nursing to give the best outcome. Doody and Doody (2011) noted that the IOWA model focuses on problem-focused triggers and knowledge in undertaking quality improvement study. The steps involved include topic selection, team formation, evidence retrieval, grading evidence, developing an EBP evidence, implementation of EBP, and evaluation of the progress. These steps apply to this DNP proposal, showing best practices, guidelines, procedures, and policies
This patient was obviously too sick to eat food by mouth to provide the energy for the body to work. However, this illness interfere with this patient digestion and absorption of nutrient, and that is one reason why this person was on TPN (DeBruyne & Pinna, 2012). Long term parenteral nutrition was required prior to surgery and then after the surgery (DeBruyne & Pinna, 2012). This person requirement
As mentioned previously we can do without food for weeks but without oxygen, we will die within a few minutes this is why nutrient imbalance is given second priotiy.Our bodies need a balanced nutritious diet to produce, substitute and repair cells and tissues; produce energy to stay warm and movement; carry out chemical processes such as the digestion of food and protect against infection and recover from sickness. (Fao, n.d.)Without balanced nutrition we won’t have the necessary energy to perform our ADLs. If we look at Mr Cooper he has a background of reflux and hypercholesterolemia. Mr Cooper has a high risk of nutrition imbalance due to inadequate nutrients due to constant vomiting up of foods, indigestion, and feeling of fullness in the upper abdomen all of which leads to loss of appetite thus loss of essential nutrients. (Nanda nursing care plan, 2012) Hypoxia also has an anorexic effect and is a key catabolic stimulus. (Mason, Parker and Lott,
“‘The doctor of the future will no longer treat the human frame with drugs, but rather will cure and prevent disease with nutrition’” (Thomas Edison). Artificial nutrition and hydration dates back to about 3,500 years ago. During this time, Ancient Greeks and Egyptians were performing “rectal feedings”. They injected enemas to insert nutrients into the rectum to preserve health. This was to protect inflamed bowel surfaces or treat diarrhea. It was made from liquids such as wine, milk, whey and wheat or barley broths. Later on, they added eggs and brandy to the mix. Nutrition is the process of consuming food that is necessary for life, health and growth. Hydration is drinking water that is from either fluids or foods. Artificial nutrition and hydration (N&H) is a treatment that gives someone fluids and/or nutrition for their body without them taking it in their mouths and swallowing it. There has been some disagreements whether or not to withdraw or withhold artificial nutrition and hydration for end of life care. “End of life care” is when healthcare workers take care of people who are at the end of their life. Whether it is because they are in old age, very ill or injured, or sick with a disease. The disagreements exist because of it being based on if it is necessary or required to use artificial nutrition and hydration.
19. When a patient discovers that they’re terminally ill, they may get depressed or even see no reason to continue living. They may stop eating or reduce the amount of food they eat because of their anger, depression, or just ultimately feel as if nothing will help their situation. In my nutritional care, I would encourage the family to continue supporting the patient through their difficulties. They should motivate him to stay positive during these hard times. I would personally encourage the patient to remain optimistic. 3 questions I would ask is: What does he usual eat while home? Does he usually finish his meals. Being the family of this patients what wishes or concerns do you possess?
Evidence-based practice is important to consider when researching for interventions, further knowledge, or help to guide a new idea in the health professions. Evidence-based practice is comprised of three significant concepts: respect and awareness for the targeted population’s values, previous clinical practice or experience with that population, and systematic research to establish a better understanding of what is already known about the study’s focus. These concepts are all taken into consideration when designing and conducting a study because it provides a more valid and credible source for others.
Evidence-based practice integrates best current evidence with clinical expertise and patient/family preferences and values for the delivery of optimal health care (qsen.org). Like most medical professions, nursing is a constantly changing field. With new studies being done and as we learn more about different diseases it is crucial for the nurse to continue to learn even after becoming an RN. Using evidence-based practice methods are a great way for nurses and other medical professionals learn new information and to stay up to date on new ways to practice that can be used to better assess
One of the most essential aspects of doing a job well, no matter what job it is, is the ability to think critically about a situation. Finn (2011) defines critical thinking as “the ability and willingness to assess claims and make objective judgments on the basis of well-supported reasons and evidence rather than emotion or anecdote”. The difference between assessing a certain situation critically and assessing it without any evidence to corroborate your claims is that when you look at something critically, you are using your ability to “come up with the alternative explanations for events, think of research findings and apply new knowledge to social and personal problems” (Finn, 2011). When you can come up with other explanations using evidence, you can also create an alternative way of enhancing the situation. Critical thinking skills are especially important to nurses in a fast-paced setting. Nursing is a very demanding and rewarding field to enter into; it becomes enjoyable when you are good at it. In order to be good at their jobs, nurses need to learn the skills required to think critically and also, relate those skills to their everyday routines. This is known as evidence-based practice. Evidence-based practice is defined as “using the best scientific evidence available to guide clinical decisions and interventions with the goals of fostering self-management skills and improving health outcomes” (Miller, 2011). This paper examines the skills required for critical thinking, how to learn these skills, and how to apply them in clinical settings. (Miller, 2011; Finn, 2011; Noonan, 2011; Lunney, 2010; Wangensteen, Johansson, Bjorkstrom & Nordstrom, 2010; Chitty & Black, 2011).
Nursing is ever-evolving. Healthcare in general is becoming more sophisticated, which requires an increase in knowledge and education, as well as the need for nursing staff to be able to think critically. As medical advances are at an all-time high, reimbursement from state and private insurance has decreased. These factors lead to a greater need of autonomy and evidence-based research by RN’s (Huston, 2014)
Evidence - Based Nursing, An introduction (2008, p.1) “ At is core evidence based ‘anything’ is concerned with using valid and relevant information in decision making” “high quality research is the most important source of valid information”.
Nurses use evidence based practice and research to develop knowledge needed to practice in the nursing profession. Nurses use practical knowledge and theoretical knowledge in the many roles that nurses perform. As a provider of care and manager of care, nurses should use evidence based practice, research, and theoretical knowledge to ensure the best possible outcome for the patient. Lifelong education in nursing is necessary to keep up with the changes in nursing practice and to reinforce ethical knowledge and the core values that nurses use in their everyday practice. The professional value of caring as a nurse is one of the most important values. The caring attitudes of nurses will carry over to all other values that nurses should possess,
The patient may no longer be able to orally take in food, and the artificial means of feeding may worsen the patient’s quality of life. The concept of food cessation is often difficult for the patient’s friends and family to understand and accept, especially because food is essential to life, and eating is a sociocultural experience. Family must be reminded that to feed the patient may do more harm than good. However, until the time that oral intake stops, nurses must be providing other ways to increase the patient’s nutrient intake. The performance of symptom assessments and the development of plans of care should begin at the time of diagnosis and continue throughout the remainder of the patient’s life. These assessments and plans of care are both critical to preventing the onset of early malnutrition and to maintaining the patient’s quality of
In health care, evidence-based research is crucial. Nurses revolve their practice on evidence so that they may provide the best health care. Without research, there would be no evidence to prove health care related findings (Shmidt & Brown, 2012). With appropriate
Advances in evidence-based practice stem from the generation of ideas, the analysis of information, and the use of specialized expertise to answer questions. Accessing and staying current with the latest information on best practices to treat patients is a constant challenge for nurses. It is important for nurses to continually engage in research to develop evidence-based practices for those areas that may currently be
In nursing, the entire sources of knowledge are valuable, in the collective body of knowledge that represents the nursing profession. While these three sources offer nursing with crucial contributions, each contains strength and limitations (Batalden et al., 2007). Both traditional and experimental knowledge are crucial to implement but most often are based on subjective data. Therefore, nurses most often focus on scientific knowledge, commonly called evidence based practice, or also known as research-based practice (Batalden et al., 2007). That is, by linking all their sources of knowledge with information gained from their patient in which nurses are enable to deliver holistic person centered care to patients and in the wider community ( Batalden et al., 2007) .